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NATIONAL KIDNEY AND TRANSPLANT INSTITUTE Institute of Advanced Nursing and Allied Health Professionals

JOURNAL READING
NEGLIGENCE AND MALPRACTICE.

SUBMITTED BY: Jane Bernadette A. Delos Santos

Nurse's negligence proves fatal By Remedios Sarmiento On March 15, at around 8 pm, a female patient (around 24 years old) died in Ramos General Hospital due to a nurse's sheer negligence. This nurse FORGOT to put the patient's respirator back on after feeding and suctioning her. It was not until one of the family friends noticed that the tube of the respirator wasn't attached to the patient at all that they noticed that something was gravely wrong. This patient has been in a coma for a number of days due to cardiac arrest in the middle of a surgical operation to manage an ectopic pregnancy, that was done the past week and she has been under life support since. According to my dad's narration, a group of the patient's dad's friends gathered on the bedside to offer a prayer, when one of the friends pointed at the patient in shock, saying "Bro! hindi nakakabit!" (Bro! [the tube] isn't connected!) The father hastily reattached the tube of the respirator to her daughter and rushed outside to confront the nurse that fed his daughter earlier. When he reached the nurse station, my dad told me "ayta, selikut da ne (they hid him already)" They don't know his name (not YET) but they sure remember his face. Everyone who was there to see that patient specifically noticed that this nurse involved was clumsy, "mali-mali", knocking things over, and he seemed lost and clueless of what he was doing. The parents and the whole religious community that they belong to plan to take action as soon as possible, to set things right, to seek justice. Ignorance is not an excuse, and there is definitely NO EXCUSE to the error committed, especially if it involves life and death, and if the mistake done was way too simple, only someone stupid can pull it off. Let there be a lesson learned from this tragedy. A lot of us belong to the health care sector and there is no room for error. We all know this, but it takes a lot of effort to practice. In the health care field, the term malpractice originally encompassed only the negligent wrongs of a nurse. In the past, a distinct division existed between a nurse and a physician. The nurse functioned within a much more defined framework. Rather than diagnose patients, treat symptoms, or prescribe medication, it was sufficient for the nurse to wait for and then simply implement a physicians order. In years past it was virtually unprecedented for a nurse to criticize a physicians order. The role of the nurse, however, has changed. Today, nurses commonly assume functions previously performed only by the physician. In hospitals and clinics across the country, nurses have assumed the responsibilities such as the actual examination, diagnosis, and treatment of a patient, oftentimes without any direct supervision by a physician. As nursing has matured into an increasingly advanced, sophisticated, specialized, and independent profession, the nurses role in providing patient care has also expanded a reality that is particularly true in the face of the ever-increasing demand for cost-conscious health care. As a result, liability for basic nursing negligence has shifted to its professional counterpart malpractice liability.[1] No other specialty relies more heavily on nurses to assess patients and evaluate treatment options than the field of obstetrical nursing, and the stakes for the patients and families involved could not be higher. All nurses owe duties to the patients they serve. According

to the American Nurses Association, a nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.[2] Additionally, a nurse is both responsible and accountable for his or her individual nursing practice and will determine the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care.[3] In order to ensure that they are satisfying these ethical and legal responsibilities owed to their patients, modern obstetrical nurses play a prominent and important role in the evaluation of a woman as she progresses with her labor, and the ability of the fetus to successfully tolerate the labor.[4] As the person with the greatest exposure to the patients, it is oftentimes ultimately the responsibility of the nurse to make crucial assessments of patient status and effectively communicate the status reports to the physician also charged with the care of the patient. When there is a breakdown in this necessary line of communication, tragic results can follow. Nurses with specialized training or extensive experience are held to a higher standard of care, corresponding to what a reasonable and prudent nurse with the same training or experience would have done in the same or substantially similar set of circumstances.[6] Under this standard, an obstetrical nurse with vast experience and/or training will be presumed to recognize potential problems physician who restates the order or if the nurse relies on the physicians assertion that the physician will take full responsibility employed by members of the nursing profession. A nurse will be liable in tort if harm ensues because he or she does not have or use such knowledge, skill, care, or diligence.[7] A nurse that works for a hospital is legally obligated to be aware of these policies and procedures and to comply with the institutions rules and regulations.[8] Procedures, rules, regulations, and by-laws of various health care institutions can be used to define the nursing standard of care.[9] For example, a hospital s procedure manual for nurses or a nurses job description may set forth in detail specific rules of conduct for nurses. On occasion, a nurse may be confronted by a physicians order which directly conflicts with written hospital policy. If an order is not in accord with accepted medical standards, practices, customary procedures, hospital policies, or regulations, the nurse must defer, question, and even contravene the order.[10]Nurses have a duty to advocate for the patient through the organizational chain of command when they believe that the physician is unresponsive to concerns about the patients condition or is making inappropriate patient care decisions.[11] The chain of command is a specific course of action involving administrative and clinical lines of authority established to ensure effective conflict resolution in patient care situations. Nurses caring for patients have a responsibility to be an advocate for the patient. While not bearing responsibility for making medical decisions and judgments, the nurse bears significant accountability for intervening when it appears that decisions and judgments are not consistent with the standard of care. An effective communication policy that is well known by all nursing staff and physicians can, by its very existence, improve the quality of care delivered to patients, thereby improving patient outcomes and hopefully lessening the number of catastrophically injured patients. REFERENCE: http://www.pinoynurse.google.com.ph.//1573neglgence_malpractice//www.google.philippines

SUMMARY:
Negligence refers to the act of doing something or refraining from doing something that any other reasonable medical professional would do or refrain from doing in a similar situation. It goes without saying that every situation is different, and that is where the law becomes somewhat cloudy. However, when reviewing a nursing negligence case in the given article, assumptions and circumstantial evidence are taken into account to determine if there was negligence. Common examples in the story of nursing negligence include inadequate hydration, medication errors, and mental and emotional abuse. It was indicated in the article that of long-term care, there are also often injuries due to bedsores, infections and falls. Fall cases come from leaving a patient unattended for too long, ignoring his needs, or simply refusing to feed and provide water. Abuse comes in a variety of forms and, in many cases; nurses do not feel they will be reported, especially if the patient is mentally handicapped. Medication errors, bedsores, infections and falls are most frequently the result of carelessness and lack of paying attention to their patients as necessary. It is important for nurses to document their actions very closely and accurately at the time because sometimes negligence cases come about later when details are difficult to remember. Charting everything makes it easy to determine the details surrounding each action or inaction and to find a logical reason as to why it was done. This, in combination with a nurse who follows the proper scope of practice, will likely keep a nurse from being prosecuted for nursing negligence.

RECOMMENDATIONS: NURSING ACADEME


A fully-updated Instructor Manual and CD-ROM for clinical instructors. The

Instructor Manual may feature key strategies in simple to complex organization to promote and assist nursing students in lasting understanding of different nursing principles, theories and evidence-based care in promotion of patients safety in a clinical setting. It has to be up-to-date to ensure that information is current and accurate. The CD-ROM may feature photographs and videos which enhance learning and show equipments and proper techniques (the dos and donts) in performing certain procedures in clinical setting and when administering medications.
Nursing academe must reiterate to their students the importance of return

demonstration that can facilitate students learning and practicing ideal concepts in the procedure that need to be performed as they are intended to illustrate basic procedures and steps. In a sense, it is a preparation for the students to practice the ideal way of performing certain procedures which is guided and evaluated by their knowledgeable clinical instructors and it may help nursing students to perform it safely and confidently.
The nursing school must also ascertain that the scope and limitations as well as with

the duties and responsibilities of a nurse is included in the curriculum for them to be guided about the tasks that nurses might and might not do and to know those tasks that can be delegated and cannot be delegated.

NURSING SERVICE
The nursing leaders may conduct proficiency test that features situations that might

happen in clinical areas. These promote/enhance clinical thinking of nurses and for the nursing leaders to have an evaluation of the outcome if the nurses that they are evaluating are competent enough to deal with certain situations.
Uniformed or standard medical abbreviations must be applied and must be check if

this was applied in all health care setting. This must be reiterated to all practicing nurses and to all other allied health professionals for easy interpretation and promotes quality information that result to good communication among nurses and other allied health professions. Implementation of expanded coverage of qualitative and quantitative research about the most common negligence and malpractice that nurses make in the clinical setting. This is done to find and to help focus the nursing leaders attention on it for identification of remedies to be done in order to lessen the incidence of negligence and malpractice in nursing practice. After the conduction of expanded coverage of qualitative and quantitative research and evaluation of it, nursing leaders must have an open forum to identify the most common mistakes that nurses committed and omitted in nursing practice. This is significant for them to stress and deal with the further needs in clinical area. Conduction of orientation for new nurses and re-orientation for the senior nurses with regards to the policy and protocol that are provided by their institution. This is done for the nurses to be guided in practicing their professions. Distribute individual self assessment form among nurses to see what those possibilities why they are committing mistakes. This is done to raise and to assess their awareness and for them to be prepare on how to deal with it.

Conduction of seminars as a part of continuous education for nurses with regard to prevention of negligence and malpractice done by a nurse in health care settings. Seminars to be conducted must emphasize the right delegation of task, scope and limitation, duties and responsibilities of nurses, proper communication of nurses to other nurses and to allied health care professionals, and emphasis on the most prevalent negligence and malpractice nurses performed.

In line with the continuity improvement program of every institution, they must have key performance indicator to take ahead on studying. In collaboration with the nursing leaders will check the competency level of all units of their institutions with the use of evaluation tool and narrative documentation.
Provisions of wall post and manuals in every nurse stations to serve as reference

when nurses are in doubt.

Strict enforcement of policy and protocols as well as with the sanctions provided if

there is failure to follow it. Evaluation tool for the patient may be provided in every clinical setting for us nurses together with our institution assess the patients satisfaction in the care we rendered.
Nursing leaders must have harmonious relationship with their nurses. Most nurses are afraid with their superior that is why sometimes, they keep it to their selves the mistakes they committed and omitted. And for them to see if nurses are working with their duties and responsibilities in clinical settings.

Emphasis on chain of command for right delegation of tasks. The nursing service may place an organizational chart in each unit for easy identification.

PHILIPPINE NURSES ASSOCIATION


Conduction of annual convention among nursing leaders to have them raise their

concerns in every clinical setting and for them to have an open forum with regard to negligence and malpractice prevalence commonly on clinical setting. This may be done for them to assess and to plan things in dealing with it. Some drugs and medical devices presented in health care setting have Food and Drug Administration (FDA) clearance limited use in health care settings. To ensure that drug selection and dosage set forth in accordance with the current recommendations and practice, the Philippine Nurses Association and other health care provider may collaborate to FDA to ascertain the FDA status of each drug or device planned for use on clinical practice.
Implementation of strict enforcement of nursing law as well as with the sanctions

provided if there is a failure to follow it considering the ethical and legal implications of certain actions. Have a new amendment or revision if there is a need. This is done for the nurses to have strict compliance with policies and protocols and this will likely to decrease the incidence of negligence and malpractice.
Conduction of free seminars among nurses and incoming nurses. The seminars will

have an emphasis on the scope and limitation, nursing responsibilities, methods and principles in providing care for the patient. This will also have an emphasis on the common mistakes that a nurse committed in clinical area and the ways on how to minimize it. Orientation and re-orientation with the nursing law that is being implement by the Philippine Nurses Association among nursing leaders.

Have a study on negligence cases of nurses in the Philippines. For them to be able

to identify the common cause of it and to have plans in dealing with it.
Emphasis on Philippine Republic Act 9173. Nurses are protected by many laws, but

outright acts of negligence are not likely to go unnoticed and are very often reviewed in a legal sense.

IMPLICATION TO PERSONAL PRACTICE


Todays nurses enter a realm of opportunities and challenges for providing high-quality, evidencebased care in traditional as well as new and innovative health care settings. The rapid progress of negligence and malpractice in health care settings mandated us nurses to be prepared to provide or plan care for our patients. Me as a nurse can make significant contributions to the health care outcomes of patients who are hospitalized. By knowing the principles of caring patients, by being knowledgeable, and compassionate in caring patient, we nurses will less likely to commit or omit errors in the practice of our professions. We nurses must be prepared to identify our patients short term and long terms needs quickly nd to collaborate effectively with patients and families, other members of the health care team, and community agencies to create a seamless system of care. In preparing for these vast opportunities and responsibilities, we nurses must be well informed and up-to-date, not only in nursing knowledge and skills but also in research findings, scientific advances, and ethical dilemmas inherent in many areas of clinical practice. More than ever, knowing the prevalence and the most common cause of negligence and malpractice that most nurses made, as a nurse, I need to think more critically, creatively, and compassionately, and I must work cautiously in the practice setting. I should be guided with the principles and methods in application of nursing skills in health care settings. I should render my care holistically not only to follow those principles of nursing care but to work holistically for the patients wellness.